Endovascular management of ruptured distal posterior inferior cerebellar artery aneurysms

Abstract

Distal posterior inferior cerebellar artery (PICA) aneurysm is a kind of rare intracranial aneurysm with controversial evidence in managements. The main purposes of this research are to study the safety and effectiveness of parent artery occlusion (PAO) compared with selective aneurysm coiling (SAC) as well as figure out factors that affect the outcomes.All characteristics of patients that diagnosed with ruptured distal PICA aneurysm and treated with endovascular management in our hospital from July 2009 to February 2016 were retrospectively collected. Details include complete occlusion rate, procedure-related complications and Modified Rankin Scale (mRS) of 31 months (mean) follow-up.Total 36 patients finally met the criterions and were included in the present study. New imaging infarction was observed in 12 (33.33%) patients. And 10 of them showed no apparent neurological dysfunctions after 34 months (mean) follow-up; 1 remained coma status since the symptom onset; and 1 patient died. 27 (75%) patients got a mRS ≤ 2 at the discharge while 20 (86.96%) patients with 3-year follow-up after the operation. There is no significant difference between patients treated with SAC and PAO in both complications and functional recovery in 3-years follow-up period. Hunt&Hess classification (H&H), age, and hydrocephalus are risk factors for functional recovery at discharge.PAO is safe and efficient in the management of distal PICA aneurysms while complications and outcomes are similar with SAC. H&H, age, and hydrocephalus are predicting factors for the mRS at discharge. Further prospective study is still needed to confirm the results of present study.

Clinical Importance of the Posterior Inferior Cerebellar Artery: A Review of the Literature

“…Nevertheless, EVT related complications including intraprocedural ruptures and new-onset infarcts are not rare 33 . Chen's study even reported that the morbidity of EVT related imaging infarcts was up to 33%, most of them didn't show apparent symptoms fortunately 65 . A meta-analysis suggested PICA aneurysms treated with EVT had a higher recurrence rate and lower occlusion rate than those treated with surgery 35 .…”

“…EVT reduces the risk of direct brainstem injury and anesthesia related complications, which is more preferable for patients with poor clinical status 34 . EVT strategies such as stand-alone coiling, stent-assisted coiling, microcatheter-assisted coiling, flow diversion, parent artery occlusion with coils were successfully used to treat PICA aneurysms 33 , 65 - 73 . The treatments of PICA dissecting aneurysms were prone to require vessels sacrifice 38 .…”

Endovascular Therapy for an Aneurysm of a Distal Posterior Inferior Cerebellar Artery via the Ipsilateral Persistent Primitive Proatlantal Artery: A Case Report

“…Chen et al described the periphery of the distal PICA from the tonsillomedullary segment and reported that of the 36 patients with ruptured aneurysms of the distal PICA, 28 were treated with PAO and eight underwent selective aneurysm coiling (SAC). 17) PAO resulted in lower mortality (3.57% vs. 12.5%) but higher occlusion rates (100% vs. 87.5%) than SAC. Furthermore, 12 of the patients (33%) who underwent PAO experienced new cerebral infarctions, but none showed any new neurological symptoms.…”